Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1033694591 |
---|---|
Provider Name | Alison Blythe Shellman |
First Address | San Marcos, TX 78666-5066 |
Second Address | Houston, TX 77030-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2018 |
Last Update Date | 01/10/2018 |